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General NPI Number Information
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NPI Number | 1699526830
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Entity Type | Organization
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Legal Business Name | SUMMIT EYE CARE LLC
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3050 E MULLAN AVE
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City | POST FALLS
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State | ID
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Zip | 83854-8939
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Country | US
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Telephone | 986-214-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 E 925 S
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City | CLEARFIELD
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State | UT
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Zip | 84015-2377
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Country | US
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Telephone | 801-400-2068
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DAVID PEREZ
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Credential |
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Telephone | 801-787-6637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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